Single-Stage Posterior Approach for the En Bloc Resection and Spinal Reconstruction of T4 Pancoast Tumors Invading the Spine

Abstract

Study design: Retrospective cohort study.

Purpose: This study aimed to evaluate the outcomes of patients who had T4 Pancoast tumors invading the spine and underwent en bloc resection and spinal stabilization through a single-stage posterior approach.

Overview of literature: Surgical resection for Pancoast tumors affecting the spine has been successfully performed in two stages involving spinal reconstruction and tumor resection. However, reports have rarely presented the results of en bloc resection combined with spinal stabilization for T4 Pancoast tumors invading the spine through a single-stage posterior approach.

Methods: Patients who had T4N0M0 Pancoast tumors invading the spine and underwent a single-stage posterior approach were retrospectively recruited. The following data were obtained and examined: demographics, tumor histology, preoperative and postoperative therapy, complications, spinal reconstruction technique, tumor resection extent, survival time, and disease recurrence.

Results: Eighteen patients were included. The mean population age was 61±17 years, and the most common pathological type was adenocarcinoma (61.1%). Complete resection (R0) was obtained in 15 patients (83.3%), positive surgical margins (R1) were found in three patients (16.7%), and the 90-day mortality rate was 0%. Postoperative major complications were detected in 12 patients (66.7%), who required reoperation. The mean survival time was 67±24 months, but the median survival time was not reached. Among the patients, 10 (55.6%) are still alive at the end of the study. The 2- and 5-year actual survival rates were 59% (95% confidence interval [CI], 35.7%-82.3%) and 52.5% (95% CI, 28.4%-76.6%), respectively.

Conclusions: En bloc resection and spinal stabilization through a single-stage posterior approach might be effective for T4 Pancoast tumors invading the spine.

Keywords: Adenocarcinoma; Margins of excision; Pancoast syndrome; Spine; Survival rate.

Fig. 1

(A–C) Artist’s illustration of extent of vertebral body resection and spinal stabilization according to the type of spinal involvement. Adapted from Zairi F, et al. Asian Spine J 2016;10:1047–57

Fig. 2

Intraoperative photograph. (A) Posterior spinal stabilization is performed first, then a lateral incision is used to expose the chest wall. (B) En bloc resection of the tumor is carried out. (C) PYRAMESH (Medtronic Sofamor Danek USA Inc., Memphis, TN, USA) is used to complete the anterior spinal reconstruction. Adapted from Zairi F, et al. Asian Spine J 2016;10:1047–57 [17].

Fig. 3

Kaplan-Meier curve for survival from the date of surgery of 18 patients.